Abstract
Objective: To evaluate the diagnostic accuracy of fine needle aspiration (FNA) in detecting malignant parotid tumors. Design: A retrospective study of cases series. Setting: Salmaniya Medical Complex, Otorhinolaryngology Department, Kingdom of Bahrain. Methods: A retrospective study was carried out, between January 2009 and December 2018, for all patients diagnosed with parotid tumors at the Department of Otorhinolaryngology, Head and Neck Surgery at Salmaniya Medical Complex, Manama, Kingdom of Bahrain. Data collection was made from medical records, I-seha and laboratory information system (LIS). 87 patients underwent parotidectomy, of which 30 were excluded due to unsatisfactory diagnoses or missing data. The results of fine needle aspirations were analyzed and compared with the corresponding histopathologic diagnosis. Estimation of sensitivity, specificity, negative predictive value, positive predictive value and accuracy of FNA were calculated. Results: Among the 57 evaluated cases, four cases were further excluded from the final analysis due to unsatisfactory FNA results, therefore only 53 cases remained. The mean age of patients was 48.6 ± 17.2 years. A concordance with histopathology results was observed. 47 cases were diagnosed as benign and five cases were malignant, however, 1 case was diagnosed as malignant by FNA, but not in histopathology. The overall diagnostic accuracy was 98.1% and the prevalence of parotid malignancy was 9.4%. Sensitivity and specificity were 100% and 97.9%, respectively. Positive predictive value was 83.3% while negative predictive value was 100%. Conclusion: Fine needle aspiration is a highly sensitive and specific test in evaluating malignant parotid gland tumors. It is useful and accurate, especially when used hand by hand with the clinical assessment and radiological findings.
Highlights
The parotid glands are the largest of the three main salivary glands [1]
It included all patients diagnosed with parotid tumors who underwent parotidectomy with adequate medical record and we excluded all patients with missing fine needle aspiration (FNA) cytology results or histopathology results or both
Fine needle aspiration diagnoses were obtained using the direct FNA blind method in 75.4% of the cases, where as 17.5% were by using ultrasound guidance
Summary
The parotid glands are the largest of the three main salivary glands [1]. Their function is the secretion of saliva. Salivary gland tumors constitute 2% - 6.5% of head and neck tumors [6] [7] Of these 80% - 85% are located in the parotid glands [1] [6]. Mucoepidermoid carcinomas are the most common malignant lesions of the parotid glands [5] The prevalence of these tumors is inconstant among different ethnicities and populations in different geographical locations [6]. FNA was first familiarized in 1920 for the assessment of parotid lesions and gained popularity 50 years later [6]. It is safe, simple, cost-effective and minimally invasive but its accuracy is doubtful, when compared to the gold standard histopathology [7]. The aim of this study is to determine the diagnostic accuracy of FNA for detecting malignant parotid tumors preoperatively in Salmaniya Medical Complex (SMC), Manama, Kingdom of Bahrain, in which FNA accuracy had not been assessed previously
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